SDCL § 1-27-43: Form of notice of review--Office of Hearing Examiners' notice.

The following forms are prescribed for use in the procedures provided for in §§ 1-27-35 to 1-27-42, inclusive, but failure to use or fill out completely or accurately any of the forms does not void acts done pursuant to those sections provided compliance with the information required by those sections is provided in writing.

NOTICE OF REVIEW REQUEST FOR DISCLOSURE OF PUBLIC RECORDS

Date of Request: ________________________________________ Name of Requestor: ________________________________________ Address of Requestor: ________________________________________ Telephone Number of Requestor: ________________________________________

Type of Review Being Sought: ______ Request for Specific Record ______ Estimate of Fees ______ Estimate of Time to Respond Short Explanation of Review Being Sought Including Specific Records Requested: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

Name of Public Record Officer: ________________________________________ Address of Public Record Officer: ________________________________________ Name of Governmental Entity: ________________________________________ Address of Governmental Entity: ________________________________________

You must include with the submission of this Notice of Review--Request for Disclosure of Public Records form the following information: (1) A copy of your written request to the public record officer; (2) A copy of the public record officer's denial or response to your written request, if any; and (3) Any other information relevant to the request that you desire to be considered.

I hereby certify that the above information is true and correct to the best of my knowledge.

Signature of Requestor: _____________________________________________________

The Notice of Review--Request for Disclosure of Public Records form shall be completed and submitted, via registered or certified mail, return receipt, to the following address:

Office of Hearing Examiners

500 E. Capitol Avenue

Pierre, South Dakota 57501

605-773-6811

SOUTH DAKOTA OFFICE OF HEARING EXAMINERS

NOTICE OF REQUEST FOR DISCLOSURE

OF PUBLIC RECORDS

TO: (Public Record Officer & Governmental Entity) ______________________________ has filed a Notice of Review--Request for Disclosure of Public Records. A copy of the Notice of Review--Request for Disclosure of Public Records is attached for your review.

You may file a written response to the Notice of Review--Request for Disclosure of Public Records within ten (10) business days of receiving this notice, exclusive of the day of service, at the following address:

Office of Hearing Examiners

500 E. Capitol Avenue

Pierre, South Dakota 57501

605-773-6811

The Office of Hearing Examiners may issue its written decision on the information provided and will only hold a hearing if it deems a hearing necessary.

If you have any questions, please contact the Office of Hearing Examiners.

Dated this ____ day of ________________, 20____.

___________________________

Office of Hearing Examiners